|
HC HEMOSIDERIN
|
Facility
|
OP
|
$23.46
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.33
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS MAPPO |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$19.29
|
| Rate for Payer: BCN Commercial |
$18.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.87
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.87
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.16
|
| Rate for Payer: Meridian Medicaid |
$3.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$19.24
|
| Rate for Payer: PACE Senior Care Partners |
$5.57
|
| Rate for Payer: PACE SWMI |
$5.87
|
| Rate for Payer: PHP Commercial |
$19.94
|
| Rate for Payer: PHP Medicare Advantage |
$5.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: Priority Health HMO/PPO |
$20.41
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.72
|
| Rate for Payer: Railroad Medicare Medicare |
$5.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$19.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.87
|
| Rate for Payer: UHC Exchange |
$5.87
|
| Rate for Payer: UHC Medicare Advantage |
$5.87
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: VA VA |
$5.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
|
|
HC HEMOSIDERIN
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.15
|
| Rate for Payer: BCN Commercial |
$18.13
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$19.24
|
| Rate for Payer: PHP Commercial |
$19.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: Priority Health HMO/PPO |
$20.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$19.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
OP
|
$486.27
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.49 |
| Max. Negotiated Rate |
$437.64 |
| Rate for Payer: Aetna Commercial |
$413.33
|
| Rate for Payer: Aetna Medicare |
$126.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.96
|
| Rate for Payer: BCBS Complete |
$194.51
|
| Rate for Payer: BCBS MAPPO |
$121.57
|
| Rate for Payer: BCBS Trust/PPO |
$399.76
|
| Rate for Payer: BCN Commercial |
$378.07
|
| Rate for Payer: BCN Medicare Advantage |
$121.57
|
| Rate for Payer: Cash Price |
$389.02
|
| Rate for Payer: Cofinity Commercial |
$418.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.57
|
| Rate for Payer: Healthscope Commercial |
$437.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.33
|
| Rate for Payer: Nomi Health Commercial |
$398.74
|
| Rate for Payer: PACE Senior Care Partners |
$115.49
|
| Rate for Payer: PACE SWMI |
$121.57
|
| Rate for Payer: PHP Commercial |
$413.33
|
| Rate for Payer: PHP Medicare Advantage |
$121.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.08
|
| Rate for Payer: Priority Health HMO/PPO |
$423.05
|
| Rate for Payer: Priority Health Medicare |
$122.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.80
|
| Rate for Payer: Railroad Medicare Medicare |
$121.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.92
|
| Rate for Payer: UHC Core |
$406.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.57
|
| Rate for Payer: UHC Exchange |
$121.57
|
| Rate for Payer: UHC Medicare Advantage |
$121.57
|
| Rate for Payer: VA VA |
$121.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.70
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
IP
|
$486.27
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.08 |
| Max. Negotiated Rate |
$437.64 |
| Rate for Payer: Aetna Commercial |
$413.33
|
| Rate for Payer: BCBS Trust/PPO |
$396.94
|
| Rate for Payer: BCN Commercial |
$375.79
|
| Rate for Payer: Cash Price |
$389.02
|
| Rate for Payer: Cofinity Commercial |
$418.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.02
|
| Rate for Payer: Healthscope Commercial |
$437.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.33
|
| Rate for Payer: Nomi Health Commercial |
$398.74
|
| Rate for Payer: PHP Commercial |
$413.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.08
|
| Rate for Payer: Priority Health HMO/PPO |
$423.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.92
|
| Rate for Payer: UHC Core |
$406.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.70
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
OP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.29 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna Commercial |
$4,553.45
|
| Rate for Payer: Aetna Medicare |
$1,392.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,674.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,674.06
|
| Rate for Payer: BCBS Complete |
$2,142.80
|
| Rate for Payer: BCBS MAPPO |
$1,339.25
|
| Rate for Payer: BCBS Trust/PPO |
$4,403.99
|
| Rate for Payer: BCN Commercial |
$4,165.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,339.25
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$4,607.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,339.25
|
| Rate for Payer: Healthscope Commercial |
$4,821.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,017.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,406.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,540.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,553.45
|
| Rate for Payer: Nomi Health Commercial |
$4,392.74
|
| Rate for Payer: PACE Senior Care Partners |
$1,272.29
|
| Rate for Payer: PACE SWMI |
$1,339.25
|
| Rate for Payer: PHP Commercial |
$4,553.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,339.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,482.05
|
| Rate for Payer: Priority Health HMO/PPO |
$4,660.59
|
| Rate for Payer: Priority Health Medicare |
$1,352.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,589.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,339.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,714.16
|
| Rate for Payer: UHC Core |
$4,473.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,339.25
|
| Rate for Payer: UHC Exchange |
$1,339.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,339.25
|
| Rate for Payer: VA VA |
$1,339.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,017.75
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
IP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,482.05 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna Commercial |
$4,553.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,372.92
|
| Rate for Payer: BCN Commercial |
$4,139.89
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$4,607.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$4,821.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,017.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,553.45
|
| Rate for Payer: Nomi Health Commercial |
$4,392.74
|
| Rate for Payer: PHP Commercial |
$4,553.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,482.05
|
| Rate for Payer: Priority Health HMO/PPO |
$4,660.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,589.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,714.16
|
| Rate for Payer: UHC Core |
$4,473.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,017.75
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: BCBS Trust/PPO |
$127.39
|
| Rate for Payer: BCN Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.77
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS MAPPO |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.30
|
| Rate for Payer: BCN Commercial |
$121.34
|
| Rate for Payer: BCN Medicare Advantage |
$39.02
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PACE Senior Care Partners |
$37.06
|
| Rate for Payer: PACE SWMI |
$39.02
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Medicare |
$39.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.56
|
| Rate for Payer: Railroad Medicare Medicare |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.02
|
| Rate for Payer: UHC Exchange |
$39.02
|
| Rate for Payer: UHC Medicare Advantage |
$39.02
|
| Rate for Payer: VA VA |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$9.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$9.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$9.46
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.47
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS MAPPO |
$11.58
|
| Rate for Payer: BCBS Trust/PPO |
$38.07
|
| Rate for Payer: BCN Commercial |
$36.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.58
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.58
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Mclaren Medicaid |
$8.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.16
|
| Rate for Payer: Meridian Medicaid |
$8.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: PACE Senior Care Partners |
$11.00
|
| Rate for Payer: PACE SWMI |
$11.58
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: PHP Medicare Advantage |
$11.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO |
$40.29
|
| Rate for Payer: Priority Health Medicare |
$11.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.75
|
| Rate for Payer: UHC Core |
$38.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.58
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$11.58
|
| Rate for Payer: UHCCP Medicaid |
$8.56
|
| Rate for Payer: VA VA |
$11.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$37.80
|
| Rate for Payer: BCN Commercial |
$35.79
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO |
$40.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.75
|
| Rate for Payer: UHC Core |
$38.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$244.49
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.92 |
| Max. Negotiated Rate |
$220.04 |
| Rate for Payer: Aetna Commercial |
$207.82
|
| Rate for Payer: BCBS Trust/PPO |
$199.58
|
| Rate for Payer: BCN Commercial |
$188.94
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cofinity Commercial |
$210.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.59
|
| Rate for Payer: Healthscope Commercial |
$220.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.82
|
| Rate for Payer: Nomi Health Commercial |
$200.48
|
| Rate for Payer: PHP Commercial |
$207.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.92
|
| Rate for Payer: Priority Health HMO/PPO |
$212.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.15
|
| Rate for Payer: UHC Core |
$204.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.37
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$244.49
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$220.04 |
| Rate for Payer: Aetna Commercial |
$207.82
|
| Rate for Payer: Aetna Medicare |
$63.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.40
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$61.12
|
| Rate for Payer: BCBS Trust/PPO |
$201.00
|
| Rate for Payer: BCN Commercial |
$190.09
|
| Rate for Payer: BCN Medicare Advantage |
$61.12
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cofinity Commercial |
$210.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.12
|
| Rate for Payer: Healthscope Commercial |
$220.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.37
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.18
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.82
|
| Rate for Payer: Nomi Health Commercial |
$200.48
|
| Rate for Payer: PACE Senior Care Partners |
$58.07
|
| Rate for Payer: PACE SWMI |
$61.12
|
| Rate for Payer: PHP Commercial |
$207.82
|
| Rate for Payer: PHP Medicare Advantage |
$61.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.92
|
| Rate for Payer: Priority Health HMO/PPO |
$212.71
|
| Rate for Payer: Priority Health Medicare |
$61.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.81
|
| Rate for Payer: Railroad Medicare Medicare |
$61.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.15
|
| Rate for Payer: UHC Core |
$204.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.12
|
| Rate for Payer: UHC Exchange |
$61.12
|
| Rate for Payer: UHC Medicare Advantage |
$61.12
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$61.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.37
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$5.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$5.91
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,551.24
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$843.42 |
| Max. Negotiated Rate |
$3,196.12 |
| Rate for Payer: Aetna Commercial |
$3,018.55
|
| Rate for Payer: Aetna Medicare |
$923.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,109.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,109.76
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$887.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,919.47
|
| Rate for Payer: BCN Commercial |
$2,761.09
|
| Rate for Payer: BCN Medicare Advantage |
$887.81
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cofinity Commercial |
$3,054.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,840.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$887.81
|
| Rate for Payer: Healthscope Commercial |
$3,196.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,663.43
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$932.20
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,020.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,018.55
|
| Rate for Payer: Nomi Health Commercial |
$2,912.02
|
| Rate for Payer: PACE Senior Care Partners |
$843.42
|
| Rate for Payer: PACE SWMI |
$887.81
|
| Rate for Payer: PHP Commercial |
$3,018.55
|
| Rate for Payer: PHP Medicare Advantage |
$887.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,308.31
|
| Rate for Payer: Priority Health HMO/PPO |
$3,089.58
|
| Rate for Payer: Priority Health Medicare |
$896.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,379.33
|
| Rate for Payer: Railroad Medicare Medicare |
$887.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,125.09
|
| Rate for Payer: UHC Core |
$2,965.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$887.81
|
| Rate for Payer: UHC Exchange |
$887.81
|
| Rate for Payer: UHC Medicare Advantage |
$887.81
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$887.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,663.43
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,551.24
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,308.31 |
| Max. Negotiated Rate |
$3,196.12 |
| Rate for Payer: Aetna Commercial |
$3,018.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,898.88
|
| Rate for Payer: BCN Commercial |
$2,744.40
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cofinity Commercial |
$3,054.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,840.99
|
| Rate for Payer: Healthscope Commercial |
$3,196.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,663.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,018.55
|
| Rate for Payer: Nomi Health Commercial |
$2,912.02
|
| Rate for Payer: PHP Commercial |
$3,018.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,308.31
|
| Rate for Payer: Priority Health HMO/PPO |
$3,089.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,379.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,125.09
|
| Rate for Payer: UHC Core |
$2,965.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,663.43
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$130.76
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$111.15
|
| Rate for Payer: BCBS Trust/PPO |
$106.74
|
| Rate for Payer: BCN Commercial |
$101.05
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$112.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$107.22
|
| Rate for Payer: PHP Commercial |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health HMO/PPO |
$113.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.07
|
| Rate for Payer: UHC Core |
$109.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.07
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$130.76
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$111.15
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.86
|
| Rate for Payer: BCBS Complete |
$8.55
|
| Rate for Payer: BCBS MAPPO |
$32.69
|
| Rate for Payer: BCBS Trust/PPO |
$107.50
|
| Rate for Payer: BCN Commercial |
$101.67
|
| Rate for Payer: BCN Medicare Advantage |
$32.69
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$112.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.69
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.07
|
| Rate for Payer: Mclaren Medicaid |
$8.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.32
|
| Rate for Payer: Meridian Medicaid |
$8.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$107.22
|
| Rate for Payer: PACE Senior Care Partners |
$31.06
|
| Rate for Payer: PACE SWMI |
$32.69
|
| Rate for Payer: PHP Commercial |
$111.15
|
| Rate for Payer: PHP Medicare Advantage |
$32.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health HMO/PPO |
$113.76
|
| Rate for Payer: Priority Health Medicare |
$33.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.61
|
| Rate for Payer: Railroad Medicare Medicare |
$32.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.07
|
| Rate for Payer: UHC Core |
$109.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.69
|
| Rate for Payer: UHC Exchange |
$32.69
|
| Rate for Payer: UHC Medicare Advantage |
$32.69
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: VA VA |
$32.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.07
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$79.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.62
|
| Rate for Payer: BCBS Complete |
$36.16
|
| Rate for Payer: BCBS MAPPO |
$76.50
|
| Rate for Payer: BCBS Trust/PPO |
$251.56
|
| Rate for Payer: BCN Commercial |
$237.91
|
| Rate for Payer: BCN Medicare Advantage |
$76.50
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.50
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Mclaren Medicaid |
$34.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.33
|
| Rate for Payer: Meridian Medicaid |
$36.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: PACE Senior Care Partners |
$72.67
|
| Rate for Payer: PACE SWMI |
$76.50
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: PHP Medicare Advantage |
$76.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO |
$266.22
|
| Rate for Payer: Priority Health Medicare |
$77.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.02
|
| Rate for Payer: Railroad Medicare Medicare |
$76.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.50
|
| Rate for Payer: UHC Exchange |
$76.50
|
| Rate for Payer: UHC Medicare Advantage |
$76.50
|
| Rate for Payer: UHCCP Medicaid |
$34.44
|
| Rate for Payer: VA VA |
$76.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: BCBS Trust/PPO |
$249.79
|
| Rate for Payer: BCN Commercial |
$236.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO |
$266.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna Medicare |
$11.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.66
|
| Rate for Payer: BCBS Complete |
$9.41
|
| Rate for Payer: BCBS MAPPO |
$10.93
|
| Rate for Payer: BCBS Trust/PPO |
$35.93
|
| Rate for Payer: BCN Commercial |
$33.98
|
| Rate for Payer: BCN Medicare Advantage |
$10.93
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$8.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.47
|
| Rate for Payer: Meridian Medicaid |
$9.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: PACE Senior Care Partners |
$10.38
|
| Rate for Payer: PACE SWMI |
$10.93
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.41
|
| Rate for Payer: Priority Health HMO/PPO |
$38.02
|
| Rate for Payer: Priority Health Medicare |
$11.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.28
|
| Rate for Payer: Railroad Medicare Medicare |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.46
|
| Rate for Payer: UHC Core |
$36.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.93
|
| Rate for Payer: UHC Exchange |
$10.93
|
| Rate for Payer: UHC Medicare Advantage |
$10.93
|
| Rate for Payer: UHCCP Medicaid |
$8.96
|
| Rate for Payer: VA VA |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.77
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$43.70
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: BCBS Trust/PPO |
$35.67
|
| Rate for Payer: BCN Commercial |
$33.77
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.41
|
| Rate for Payer: Priority Health HMO/PPO |
$38.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.46
|
| Rate for Payer: UHC Core |
$36.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.77
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.07
|
| Rate for Payer: BCN Commercial |
$36.99
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health HMO/PPO |
$41.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.12
|
| Rate for Payer: UHC Core |
$39.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.90
|
|
